Connie’s surprise: The links between AIDS and women’s health

If you ever want to make someone’s eyes gloss over as quickly as possible, you should start by telling them you want to talk about “integration.” If that doesn’t work, you should clarify that what you really mean is that you want to talk about “a holistic approach to development.” I know this trick works, because I’ve done it more than once, including as recently as last week on my trip to Lesotho and Zambia with (RED) partners and supporters.

The trip members were there to see how their money (or their companies’ money) was being channeled by the Global Fund on the ground into life-saving AIDS programs. Throughout the week, we toured a number of Global Fund-supported clinics — and we were impressed by the impact each was having and buoyed by the optimism of the beneficiaries with whom we met. But we also had other site visits scheduled, including trips to see Feed the Future’s work on biofortified, nutritious crops and to see a Pink Ribbon Red Ribbon cervical cancer center. Upon reviewing the itinerary, many of the trip participants asked us why we were spending some of our limited time focused on projects that weren’t related to AIDS. This of course cued me to respond enthusiastically with the “holistic approach” line, largely to effect described above.

Thankfully, the trip’s setup brought the delegates into contact with two individuals who were able to answer their question in a much more human and compelling way. As I described in an earlier post, we were able to reconnect with a number of the individuals featured in (RED)’s Lazarus Effect film and campaign, including Connie and Motselisi, in their home countries of Zambia and Lesotho. They were poster children (literally and figuratively) for the life-restoring power of antiretroviral treatment, and the delegates were eager to meet with them and hear more about their experiences living with AIDS.

But with each updated story, the delegation also began to understand why focusing on AIDS alone wasn’t sufficient. In Motselisi’s case, we were thrilled to see that AIDS had not been a death sentence for her. No longer gaunt and ravaged by HIV, she was a happy little 5-year-old girl who played with us and showed a big smile at the sight of chocolate candy. But you could also tell that Motselisi’s growth had been stunted; she looked like she couldn’t be much older than 3. In speaking with her family and health workers from her village, it was clear that Motselisi—like so many other children in Lesotho—was probably malnourished, eating a limited diet without sufficiently diverse nutrients to help her grow up and reach her full potential. So for the first time, we saw why integrating good nutrition programs with other health services, including those for HIV, was so critical.

In Connie’s case, we were excited to catch up with her because we knew she had big news: she was more than 7 months pregnant and on track to give birth to an HIV-negative girl, thanks to treatment to prevent mother-to-child transmission. But as we toured an innovative program in Zambia designed to link HIV clinics with efforts to screen for cervical and breast cancers in women, we learned that Connie had another surprise for us.

She revealed that a year ago, she had been tested and had found out she had precancerous lesions in her reproductive system. Having already fought AIDS, she told us, she didn’t want to risk another ongoing health challenge, and so had gone to Dr. Parham (a cervical cancer treatment pioneer from the University of Alabama Birmingham working at the clinic in Zambia) asking him to remove her uterus. He refused, telling her that there was treatment available that could restore her health while preserving her ability to have children in the future. After much back and forth, and convinced she would never have another child, Connie was convinced by Dr. Parham and agreed to have the treatment. Now, seven months into her pregnancy, her growing belly is a testament to the power of comprehensive health services for women, and the value of not just focusing on her HIV. The delegation (myself included) was blown away. All along we had been celebrating Connie for her triumph over AIDS and for her impending childbirth, without having realized that she was recently close to being unable to have a child at all.

This trip with (RED) reinforced to us that the fight against AIDS is unbelievably important, and investments in that fight must be sustained. But our site visits also drove home the message that fighting AIDS without tackling a broader range of health and development challenges will not win the war. From now on, instead of “holistic development,” I’m grateful that I can talk about Motselisi and Connie—two individuals and two stories that we all felt so lucky to have learned from.